Laparoscopy

Laparoscopic surgery (also referred to as conservative surgery), is a minimally invasive procedure that is used to diagnose endometriosis, as well as to remove endometriosis lesions or scar tissue. It’s possible that an individual may experience pain relief or fertility improvements after lesions or scar tissue are removed. Laparoscopic surgery may be recommended if other methods, such as pain medications or hormone therapy, are not alleviating symptoms. Laparoscopic surgery is also used to address ovarian cysts, in a procedure called a cystectomy.1

What happens during laparoscopic surgery?

A laparoscopy is a minimally invasive surgical procedure that involves inserting a small, thin, camera-containing device into the abdomen to view the structures inside. This device is called a laparoscope, and it sends real-time footage back to the surgeon performing the procedure so that they can identify and assess any issues. In relation to endometriosis, your surgeon will look for any endometriosis lesions within your pelvis. If they see anything abnormal, including potential endometriosis patches, they will take a small sample of this tissue and send it to a pathologist for further investigation. This is called a biopsy. A pathologist is someone who is trained in looking at tissues underneath a microscope in order to diagnose different conditions.2,3

Biopsies are often performed during an individual’s first laparoscopic surgery to definitively diagnose endometriosis. However, even if you have had previous biopsies and your surgeon is confident that you have endometriosis, they still may take additional biopsies in subsequent procedures, just to make sure nothing else is going on.

The location of the surgical incision can depend on what structures inside the body your provider is trying to get a closer look at. The procedure is performed by a surgeon, who may or may not be your gynecologist, depending on what your gynecologist has specialized in. The procedure is usually performed under general anesthesia, which means the person undergoing the surgery is asleep. The abdomen is also filled with gas during laparoscopic surgery to allow for better viewing of the internal structures.2,3

If your surgeon finds endometriosis lesions or scar tissue (also called adhesions) that need to be addressed, they will attempt to remove or destroy them. In some cases, these lesions may be able to be removed, in a process called an excision. During an excision, a lesion or scar tissue will be excised, or cut, and removed from the body. In some cases, a lesion or scar tissue may be removed using extreme heat or energy. A lesion or scar tissue is said to be ablated when high heat is used to melt it away (also referred to as coagulation). Further breaking down the technique of ablation, lesions can be melted away and destroyed using lasers (vaporization) or electrical current (fulguration). Your surgeon will inform you on what procedure they plan to use during your laparoscopic surgery, and how their approach may impact your recovery. When addressing a cyst (cystectomy), the mass may be cut out, partially removed, or drained.1,4,5

What happens after laparoscopic surgery?

Many individuals go home the same day after laparoscopic surgery. When an individual goes home the same day they had a procedure, it is referred to as an outpatient procedure. However, depending on what occurred during your procedure, it may be necessary for you to stay overnight. After the procedure, you may feel sleepy or uncomfortable from any remaining gas inside your abdomen, as well as sore at your incision site. Many people are able to go back to their normal activities within a few days of the procedure.1-3

What are the risks of laparoscopic surgery?

Since laparoscopic surgery is minimally invasive and only requires a small incision, there are fewer risks that accompany it (when compared to open surgery or more invasive procedures). The main risks of laparoscopic surgery for the treatment of endometriosis include, but are not limited to:

Scar tissue formation after surgery (formation of adhesions) which can create similar symptoms as before the procedure

Damage to structures within the pelvis, such as the bladder, bowel, or uterus (especially if lesions were addressed on these structures)

Infection, specifically pelvic infections

Uncontrolled bleeding1

This is not an exhaustive list of all of the risks of laparoscopic surgery. Consult your provider or surgeon about your specific risk profile, and what warning signs you should be on the lookout for.

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Health Information: Laparoscopic Surgery for Endometriosis. University of Wisconsin Hospitals and Clinics. https://www.uwhealth.org/health/topic/surgicaldetail/laparoscopic-surgery-for-endometriosis/hw101171.html. Published October 6, 2017. Accessed May 5, 2018.

Laparoscopy. The American College of Obstetricians and Gynecologists. https://www.acog.org/Patients/FAQs/Laparoscopy. Published July 2015. Accessed May 5, 2018.

Diagnostic Laparoscopy. Society of American Gastrointestinal and Endoscopic Surgeons. https://www.sages.org/publications/patient-information/patient-information-for-diagnostic-laparoscopy-from-sages/. Published March 1, 2015. Accessed May 5, 2018.